The Level 1 Waiver Handbook

Transcription

1 Ohio Department of Mental Retardation and Developmental Disabilities The Level 1 Waiver Handbook A Guide To: What Services are Covered? For How Much? And Who is Eligible? May 2003 ohiosearchkeydmr

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3 The Level I Waiver Handbook 3 Introduction The Level I Waiver is new and is for people with mental retardation or developmental disabilities. With the waiver, Medicaid will allow people to stay in their home and get support rather than require them to live in an Intermediate Care Facility for the Mentally Retarded (ICF/MR). The Level I Waiver offers seven different services with set spending limits, but some of the limits can be changed with the prior OK from your County Board of MRDD. The services are: Homemaker/Personal Care Institutional Respite Informal Respite Transportation Personal Emergency Response Systems Specialized Medical Equipment and Supplies Environmental Accessibility Adaptations Emergency Assistance This guide is to help you understand this waiver, learn about the services it provides and eligibility requirements. The guide is divided into sections: Who Is Eligible? What Services Are Covered? Definition of Services Who Can Help Me Get A Level I Waiver? Where are the Rules For This Waiver? When Will People Get This Waiver? Who Provides Services Paid For With This Waiver?

4 4 The Level I Waiver Handbook Table of Contents Introduction....3 Who Is Eligible?...5 What Services Are Covered? Homemaker/Personal Care...5 Institutional Respite...5 Informal Respite...5 Transportation...5 Personal Emergency Response Systems...6 Specialized Medical Equipment and Supplies...6 Environmental Accessibility Adaptations...6 Emergency Assistance...7 Definitions...8 Respite Care...8 Homemaker/Personal Care...8 Transportation....9 Specialized Medical Equipment and Supplies...9 Home Modifications (or Environmental Accessibility Adaptations)..9 Personal Emergency Response System...10 Emergency Assistance...10 Who Can Help Me Get A Level I Waiver?...11 Where Are The Rules For This Waiver?...11 When Will People Get This Waiver?...11 Who Provides Services Paid For With This Waiver?...11

5 The Level I Waiver Handbook 5 Who Is Eligible? The Level I Waiver is for people with mental retardation or developmental disabilities who Require the care given in an Intermediate Care Facility for the Mentally Retarded (ICF/MF) but want to live at home. Have a network of families, friends, neighbors and professionals who can safely and effectively provide the needed care. The cost for this help cannot be more than what the Level I Waiver allows. What Services Are Covered? Homemaker/Personal Care Institutional Respite Informal Respite Transportation Personal Emergency Response Systems Specialized Medical Equipment and Supplies Environmental Accessibility Adaptations Emergency Assistance Service Annual Limit Homemaker/Personal Care $1,000 Institutional Respite $1,000 Informal Respite $2,500 Transportation $ 500 These each have annual limits, BUT with prior authorization, the limits of coverage may be exceeded up to a combined benefit of $5,000 in EACH year THE INDIVIDUAL IS ENROLLED.

6 6 The Level I Waiver Handbook What does that mean? For example, if all your transportation needs are taken care of for you by your family, but you need a little more homemaker/personal care, you can increase the $1,000 annual limit for homemaker/personal care to $1,500. Of course, this can only be done with the prior OK of your County Board of MRDD. Your budget would then be: Service Annual Limit Homemaker/Personal Care $1,500 Institutional Respite $1,000 Informal Respite $2,500 Transportation $ -0- The total limit for these four services can never be more than $5,000 a year. But, remember, they can be changed according to your needs and with the OK of the County Board of MRDD. The following services have limits on the three-year approval period for the waiver. Service 3-Year Limit Personal Emergency Response Systems $2,000 Specialized Medical Equipment and Supplies $2,000 Environmental Accessibility Adaptations $2,000 EXCEPT, with prior authorization, Environmental Accessibility Adaptations can be approved at a higher amount IF the total of these three services does not exceed $6,000 over the three-year life of the waiver. What does this mean? First, Environmental Accessibility Adaptations are changes to your home to make it easier for you to get around. They are called many things,

7 The Level I Waiver Handbook 7 including home modifications, home mods or changes to your home. These changes might be a ramp to your front door or a railing in your front hall. You can spend up to $6,000 for changes to your home to make it easier to get around if this is where the need is the greatest and you get the prior OK from the County Board of MRDD. This would mean you would have no money for Personal Emergency Response Systems or Specialized Medical Equipment and Supplies for the 3-year life of the waiver. With the change, your plan would look like this: Service 3-Year Limit Personal Emergency Response Systems $ -0- Specialized Medical Equipment and Supplies $ -0- Environmental Accessibility Adaptations $6,000 Only the home modifications category (Environmental Accessibility Adaptations) can be increased. The most that can ever be spent for a Personal Emergency Response System or Specialized Medical Equipment and Supplies is $2,000 each over the three-term of the waiver. Remember, the County Board of MRDD must OK the change. Finally, the limit for emergency assistance is $8,000 for the three-year life of the waiver. Service 3-Year Limit Emergency Assistance $8,000 What does this mean? Emergency Assistance is help for you when something unexpected happens. If a family member who cares for you is put in the hospital for several weeks, you would qualify for emergency help. The limit for emergency help is $8,000 for three years. Or if you have an emergency and need more help than your caregiver can give you, Emergency Assistance would help pay that care. Remember, the limit is $8,000 for three years.

8 8 The Level I Waiver Handbook Define these services, please Respite Care Respite Care is support on a short-term basis for the person who receives the waiver to give family members a break. Informal Respite can be provided in a person s home, the home of a friend or family member of the individual or at sites of community activities; or Institutional Respite means the care is provided in a Medicaid-certified Intermediate Care Facility for the Mentally Retarded (ICFMR) or a facility licensed by the State Department of MRDD. Homemaker/Personal Care Homemaker/Personal Care is provided in a person s home and helps a person with daily living activities such as personal hygiene, dressing and eating. Homemaker/Personal Care services include: Basic personal care and grooming: bathing, hair care and help with clothing. Helping the person to and from the bathroom. Help with medications that are usually self-administered when ordered by a doctor. Household services essential to a person s good health and comfort such as changing bed linens. Light cleaning in areas of the home used by the person. Preparation of a shopping list, grocery shopping and meal preparation. Laundry. Other neighborhood errands including going to medical appointments or taking short walks. Other activities that ensure a person s safety, health and welfare of the enrolled person.

9 The Level I Waiver Handbook 9 Transportation Transportation enables people on the waiver to travel to waiver and community services, activities and resources. Whenever possible, family, neighbors, friends or community agencies that can provide the Transportation without charge will be used. Specialized Medical Equipment and Supplies Specialized Medical Equipment and Supplies include: Devices, controls or appliances that allow people to do daily living activities or to help them communicate; Items necessary for life support and the supplies and equipment necessary for upkeep; and Durable and non-durable equipment that is not paid for by the Medicaid State plan. Home Modifications (or Environmental Accessibility Adaptations) Home Modifications (Environmental Accessibility Adaptations) are changes to a home that enable a person to function with greater independence. Examples of Home Modifications are: Installing ramps and grab-bars Widening doorways Modifying bathrooms to be wheelchair accessible Installing specialized electric and plumbing systems to accommodate medical equipment

10 10 The Level I Waiver Handbook Personal Emergency Response System A Personal Emergency Response System is an electronic device that a person with disabilities uses to get help in an emergency. For example, the system may be a portable help button connected to a person s phone that is programmed to send a signal to a response center when the help button is activated. Trained professionals staff the response center. To qualify for a Personal Emergency Response System, a person must Live alone and/or can be alone for significant parts of the day, and Have no regular caregiver for extended periods of time, and Otherwise require extensive routine supervision. Emergency Assistance Emergency Assistance provides increased levels of any covered service in crisis situations EXCEPT FOR Informal Respite. Emergency situations are: Involuntary loss of home for any reason, including legal action. Loss of caregiver including death of a caregiver or changes in the caregiver s mental or physical status that makes them unable to do their duties. Abuse, neglect or exploitation of the person. Health and welfare conditions that post a serious risk of immediate harm or death to the person. Significant changes in the emotional or physical condition of the person that requires more support than the current caregiver can provide.

11 The Level I Waiver Handbook 11 Who Can Help Me Get A Level I Waiver? To apply for the Level I Waiver or another waiver for people MRDD, contact your County Board of MR/DD. Where Are The Rules For This Waiver? The rules are available on the Ohio Department of MR/DD website: When Will People Get This Waiver? Enrollment is expected to begin in May 2003 after the rules are effective. Certification of existing and interested providers can start as well once the rules are effective. Who Provides Services Paid For With This Waiver? Individuals receiving Level I Waiver services can select providers of their choice. Individuals or agency applicants who are interested in providing Level I Waiver services may apply for certification through the Ohio Department of MR/DD. Each Level I Waiver service has a different certification requirement. Certification must be obtained before delivering services to people enrolled on the Level I Waiver. For information about the certification process or requirements, call the Provider Certification Support Line at (877)

12 The Mission of the Ohio Department of Mental Retardation and Developmental Disabilities: To ensure the availability of services and support that help people live the life they choose, to promote their health and safety and to help and support the families of these people in achieving these goals. Bob Taft, Governor Kenneth W. Ritchey, Director Ohio Department of Mental Retardation and Developmental Disabilities 1810 Sullivant Avenue Columbus, Ohio (614)